The University of Kentucky's Cancer Control Program, Department of Behavioral Science , Kentucky Cancer Program, and community partners are proposing a five-year, community-based, participatory project to increase colorectal cancer screening in rural Appalachian Kentucky (51 counties in eastern Kentucky). Compared with the rest of the U.S., Appalachian Kentucky is medically underserved, economically distressed, and disproportionately burdened with different types of cancer. Data from the Behavioral Risk Factor Surveillance System indicates that approximately 36% of respondents in Appalachian Kentucky reported screening for colorectal cancer (FOBT or flexible sigmoidoscopy or colonoscopy) in accordance with guidelines of the US Preventive Services Task Force compared to 43.5% in Kentucky and 53% nationwide. Specific aims of this project are to: 1) Build on a foundation of community partnerships in Appalachian Kentucky and develop a network of community partners capable of fostering colorectal cancer screening;2) Use results from a pilot project and, in collaboration with community partners, pretest an intervention to increase screening for colorectal cancer in rural Appalachian Kentucky;3) Recruit primary health care providers for the project, conduct a baseline assessment and implement an intervention to increase colorectal cancer screening in primary care practices;and, 4) Evaluate the effectiveness of the intervention in increasing colorectal cancer using a randomized design involving primary care practices assigned to intervention or control based on a readiness to change score and conduct qualitative key informant interviews and process evaluations. Methods for achieving these aims are described in detail in Section D (Research Design and Methods) and include conducting focus groups, recruiting 64 primary care practices (32 control, 32 intervention), delivering an educational intervention consisting of 4 modules, collecting colorectal cancer screening data from 60 medical records/intervention practice, and assessing the impact of the intervention.